Navigating UCLA Health Open Enrollment: A Comprehensive Guide

Open Enrollment can feel overwhelming. This annual period is when you can renew or make changes to your medical insurance coverage. Selecting insurance can be confusing and time-consuming. However, investing time and effort in carefully reviewing your health insurance options might save you money, bring peace of mind, and protect you from unexpected financial burdens should a health emergency occur. Regina D. Green, director of managed care operations for UCLA Medical Group, offers insights into what to consider during Open Enrollment to make the process more user-friendly.

Understanding Key Insurance Terms

Before diving into plan specifics, understanding common insurance terms is essential:

Coinsurance: The percentage of the cost for services and treatments for which you’re responsible.
Copay: The amount your insurance charges you for doctor visits, generally a flat fee. It may be $10-$30 (or more) for office visits and up to several hundred dollars for hospital admission.
Deductible: The amount you must pay for medical services during the calendar year before the insurance company pays.
HMO (Health Maintenance Organization): With this plan, you pick a primary care physician through whom all your health care services go. Visits to doctors outside the HMO network typically aren’t covered by these plans.
Network: The set of providers - physicians, specialists, clinics, and hospitals - that accept your insurance plan’s coverage.
Out-of-pocket maximum: The amount you must pay during the calendar year before the plan pays 100% of covered charges. However, what counts toward this annual maximum varies by plan.
PPO (Preferred Provider Organization): More flexible than an HMO, PPO plans don’t require a primary care doctor and cover access to doctors both in and out of network, though staying in network generally means lower copays and out-of-pocket costs.
Premium: The monthly fee charged for coverage by your employer or insurance provider.

Factors to Consider Based on Age and Life Stage

Your health insurance needs evolve throughout your life. Here's a breakdown of factors to consider at different ages:

20s to 30s: Starting Your Healthcare Journey

Once you age out of your parents’ insurance plan at 26, you’re responsible for your own medical coverage. Provided you’re generally healthy, your focus at this age is likely to be on preventive care and treating common illnesses. Green suggests looking for a primary care physician you’re comfortable with and taking note of the hospital and clinic locations covered by a plan: Are they near your home or workplace?

“You need to consider where and when you are going to want to seek health care,” she says. “Are you the kind of person who’s proactive and schedules appointments? Or are you more the 11th-hour type who’s going to show up at urgent care?”

Young people with children should consider the needs of everyone who will be on their plan. Is there a pediatrician nearby? Do the children have health concerns that might require specialists or prescription medication?

You can access UCLA Health providers through HMO and PPO plans provided by your employer or through Covered California. Go to uclahealth.org/health-plans#ppo for more information.

40s to 60s: Balancing Family, Work, and Health

People in this age range require more preventive exams, such as mammograms and colonoscopies, so consider the locations that offer these services when looking at what’s available in a plan’s network. Because most of this population is still working, often while raising families and caring for older relatives, convenience is key. Green advises taking geography into account so services can be easily coordinated.

An unexpected health event could end up costing thousands, so it might be worth a higher monthly premium in exchange for a lower deductible and out-of-pocket limits. Look closely at the specifics of the various plans being offered to avoid a costly medical bill surprise.

“It’s no different than buying anything else,” Green says. “When you buy a car, when you buy a refrigerator, when you buy a washer-dryer: There are things that are included and things that aren’t.”

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You can access UCLA Health providers through HMO and PPO plans provided by your employer or through Covered California.

Older Than 65: Navigating Medicare and Beyond

Older adults may have the most to consider when it comes to choosing a health plan. While some older adults continue to work and have coverage through their employer, some are retired and on fixed incomes and may be more likely to have developed health conditions that require frequent care.

Green recommends people in this age category compare benefit plans based on the services they know they use. They might take inventory of the care they required over the past year to help assess the future year’s potential needs.

There are multiple types of medical plans available to seniors through Medicare. Original Medicare and Medicare Advantage are the two largest. Also think about prescription medication needs. Medicare covers prescriptions through its pharmacy drug plans known as “Part D,” but you’ll want to be sure the drug plan you chose covers the medications you take.

Knowing your health conditions and prescription requirements is key, as out-of-pocket costs can vary greatly between plans. For instance, if you regularly show up in the Emergency Department or have required long hospital stays in the past, you want to be sure to factor these concerns into your coverage selection. Plans have different out-of-pocket fees for Emergency Department visits and some plans only cover a portion of the hospital stay.

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Added perks are another potentially important consideration. Some plans include travel vouchers for rides to medical offices; others might cover acupuncture or chiropractic care. That’s why it’s important to know your needs and read closely what each plan offers.

UCLA accepts several Medicare plans, including Original Medicare and Medicare Advantage.

Understanding Medicare

Medicare provides health insurance for U.S. citizens and legal residents 65 and older. People younger than 65 who receive Social Security Disability Insurance, or those with end-stage renal disease or ALS, also qualify. Medicare is made up of many different “parts.” Original Medicare constitutes Parts A and B. Part D, which covers prescription drugs, is optional, as is Medicare Supplement insurance, also called Medigap. Then there’s Medicare Advantage, often called Medicare Part C, a separate insurance plan that includes Parts A and B, usually Part D and other benefits.

“It can be a little daunting,” says Scott Salmon, an independent insurance agent and owner of MedAssure, who helps people figure out what Medicare plans best suit their needs. “What makes Medicare Advantage increasingly popular is the lower cost as well as the additional benefits not covered by Medicare.”

The biggest misconception about Medicare, he says, is that it’s free. It’s not. And Medicare alone doesn’t cover all health care expenses.

There’s no monthly premium for Medicare Part A, also known as “hospital insurance,” for people who have paid Medicare taxes in the United States for at least 10 years. People whose spouse paid such taxes also are eligible for Medicare.

But there’s a standard monthly premium for Part B - which covers doctor visits, emergency care and other medical services - that can cost several hundred dollars, depending on one’s income. Original Medicare only covers about 80% of health care expenses, excluding prescription drugs.

“If you don't have additional coverage, you're responsible for the remaining 20%, and there’s no cap,” Salmon says. “This could really expose you financially if you had a major medical issue.”

When to Sign Up for Medicare

People are eligible to enroll in Medicare during a seven-month window called the “initial election period” around their 65th birthday - three months before, the month of, and three months after. However, those who have health insurance through their employer or their spouse’s employer (provided it’s a company with at least 20 workers) can continue with that existing coverage. After retirement, they have eight months to enroll in Medicare to avoid “late enrollment penalties” that continue in perpetuity.

People who are not employed or who work for a company with fewer than 20 employees generally must enroll in Medicare during the seven-month window of eligibility to avoid these fees.

Salmon says some people enroll in Medicare Part A at age 65 even if they won’t be using it because they still get health coverage through their employer, just to get in the system and avoid late enrollment penalties down the road.

Understanding Original Medicare: Parts A and B

Original Medicare comprises Parts A and B. Part A is for hospitalization, hospice and skilled nursing home care. Part B helps cover doctor visits, emergency care and routine outpatient hospital services, such as diagnostic tests and lab and radiology services. When someone enrolls in Medicare, they are enrolling in these two parts, which together cover about 80% of health care expenses, except for prescription drugs. There is a monthly fee for Part B, which is typically deducted from one’s Social Security check. People who aren’t receiving Social Security are billed quarterly for their Part B premiums. The premium for Part B is based on standard adjusted gross income, which Medicare modifies every year.

Medicare Terminology

Because Original Medicare only covers about 80% of health care expenses, most people opt for a supplemental insurance plan to cover the other 20%, Salmon says. Various insurance companies offer Medicare Supplement policies, with premiums typically determined by a person’s age and where they live.

Parts A and B and Medicare Supplement insurance still don’t cover prescription drugs outside of a medical setting. So, for example, anesthesia or chemotherapy drugs received while in the hospital are covered, but not the cholesterol medication or blood thinners you may take at home. Prescription coverage comes under a separate plan, known as Part D, sold by private carriers.

Even with a Medicare Supplement coverage plan, Original Medicare doesn’t include vision or dental benefits, which are sold separately.

What is Medicare Advantage?

Medicare Advantage is also a separate insurance plan - one that bundles Parts A and B, typically Part D drug coverage, as well as other ancillary benefits.

“Medicare Advantage is an all-in-one separate insurance plan option,” Salmon says. “All the top plans in L.A. have some form of routine dental, routine vision and hearing aid coverage included.” Medicare Advantage plans may also offer additional benefits such as an over-the-counter allowance to cover the cost of vitamins, allergy medications and pain relievers; chiropractic and acupuncture treatments; transportation to and from medical visits; and gym memberships, he adds. Different plans offer different benefits.

The most common Medicare Advantage plans are of the HMO - or Health Maintenance Organization - variety, which uses a network of providers for services. The other option is PPO, or Preferred Provider Organization, which also relies on a network of providers, but allows for out-of-network visits for an additional cost.

People often mistakenly believe that Medicare Advantage plans are automatically PPOs, Salmon says. They can be, but you must choose that option when you sign up.

“People have to understand that when they sign up for a Medicare Advantage plan, they’re assigning their Medicare benefits - that Part A and B card from the government - to the plan they’re enrolling in,” Salmon says.

Enrollment Periods

Just like with medical insurance provided by an employer, there are limited times during the year when individuals can change their coverage or choose a different plan. Initial enrollment in Medicare and any additional plans, however, is timed to one’s 65th birthday or retirement from employer-provided insurance after age 65.

The Medicare annual enrollment period is Oct. 15 to Dec. 7, when people can join, drop or switch plans. People with Medicare Advantage can make changes during the Medicare Advantage open enrollment period from Jan.

UCLA Health Open Enrollment Updates and Key Changes

UCLA's Open Enrollment period offers opportunities to evaluate and adjust your health benefits. Here are some key details regarding UCLA Health benefits:

Key Takeaways

Open Enrollment begins Oct. 30 - Nov. 21, 2025
A new plan option, HealthSavings+ is being launched
Minimizing impacts of health-care cost increases remains a top priority
UC will increase its contribution to medical premiums

UC’s Contribution

In 2026, UC will invest an additional $260 million in medical benefits - a 9.5% increase and the largest boost in the past 15 years. This brings UC’s total investment to $3 billion, covering 83% of medical premium costs while continuing to pay 100% of dental and vision premiums. While these decisions will help keep the average employee premium increases low, the impact to you will depend on the plan you choose.

Key Changes to UC Benefits

HealthSavings+ is replacing CORE and UC Health Savings Plan, with new benefits and costs. HealthSavings+ will be UC’s lowest premium medical plan, and it includes a Health Savings Account (HSA) that lets you set aside money for health expenses while lowering your taxable income.

Employee premiums will be more equitable and predictable. The site will fully launch Oct. 27, 2025.

Resources to Help You Choose

ALEX: Offers a customized comparison of medical plan premiums, out-of-pocket costs and in-network providers. Information for 2026 will be available in ALEX by October 29, 2025.
Calendar of Events: Check out the Calendar of Events for Open Enrollment to attend informative webinars and workshops.
UCLA Open Enrollment Vendors' List: A must-have resource for participating in the virtual Open Enrollment Webinar Fair.

UCLA Health Care Facilitator Open Enrollment Help Desks

The Zoom help desk sessions are run in a Live Q&A format and are offered during Open Enrollment period. Review the 2026 Retiree Open Enrollment Highlights below or on our YouTube page. We highly encourage you to listen to the prerecorded OE presentation, which contains all the details about OE and highlights any recent changes. This will help us use our time more efficiently and allow you to bring forward any remaining questions you may have. NOTE: The UCLA Health Care Facilitator (HCF) is here to assist with escalated medical, dental and vision plan issues that you have not been able to resolve on your own. The HCF is not your first point of contact for any issue. UC retiree plans are maintained by RASC. RASC is responsible for resolving your eligibility and enrollment issues when you have retiree coverage.

Important Considerations and Where to Find Help

While it may be tempting to base your insurance choice on monthly premiums alone, it’s worth taking a detailed look at your personal and family health needs and different plan specifics before locking in your coverage for the coming year.

Open Enrollment Period

Open Enrollment dates vary by employer and insurance provider, but the period is generally in the fall for coverage that begins the following year. For those who purchase insurance through Covered California, the Open Enrollment period is from Nov. 1 to Jan. 31. Medicare's Open Enrollment window began Oct. 15 and runs until Dec. 7. Nationally, the Open Enrollment period goes from Nov. 1 to Jan. 15.

Still Stumped? Where to Find Help

If you get your insurance coverage through your employer, your Human Resources department should be able to help. You can also call your insurance company directly to ask questions.

If you buy your insurance through the marketplace and live in California, start at coveredca.com.

Outside California, go to healthcare.gov and click on “find local help” for information about coverage in your state.

Understanding Your Plan's Coverage

Look beyond the leaflet you may have been given with a grid offering simple plan comparisons. For detailed information about what is and isn’t covered by your insurance plan, read the Evidence of Coverage. This detailed document is lengthy but worth the time, both when choosing coverage and as a reference when needs arise.

Green advises: “Take notes like you were in class.”

What if You Miss the Open Enrollment Period?

If you miss the Open Enrollment period, you are generally stuck with your current coverage unless you experience a Qualifying Life Event that makes you eligible for a special enrollment period.

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